水晶体融解緑内障を前房穿刺で治療した1例

A case of phacolytic glaucoma treated by paracentesis

要約　目的：全身麻酔が困難な水晶体融解緑内障に対し，前房穿刺が奏効した症例の報告。症例：80歳女性が右眼白内障手術の目的で受診した。幼少時から右眼の視力が不良であり，左眼には25年前に白内障手術が行われた。喘息，虚血性心疾患，脳梗塞，認知症があった。所見：矯正視力は右手動弁，左0.4で，眼圧は右10mmHg，左6mmHgであった。右眼に過熟白内障，左眼に眼内レンズが挿入されていた。角膜内皮の密度は右2,000/mm²，左500/mm²であった。全身状態が不良であるために，右眼への白内障手術は見送られた。経過：4か月後に右眼痛が生じ，眼圧は右63mmHg，左12mmHgで，右前房が混濁し，過熟白内障に伴う水晶体融解緑内障と診断した。緊急措置として27G注射針による前房穿刺を行った。総計7回の前房穿刺で眼圧は20mmHg以下になり，9か月後の現在まで経過は良好である。結論：全身麻酔が困難な水晶体融解緑内障に対し，注射針による前房穿刺が奏効した。

Abstract.　Purpose：To report a case of phacolytic glaucoma treated by repeated paracentesis. Case：An 80-year-old female was referred to us for cataract in the right eye. Her right eye had been amblyopic since childhood. The left eye had received cataract surgery 25 years before. She had brochial asthma, ischemic cardiopathy, cerebral infarction, and dementia. No surgery was performed on the right eye. Findings：Corrected visual acuity was hand motion right and 0.4 left, with intraocular pressure（IOP）of 10 mmHg right and 6 mmHg left. The right eye showed hypermature cataract and the left eye showed intraocular lens. No surgery was performed on the right eye because of poor systemic status. Clinical Course：The right eye showed severe pain 4 months later. IOP was 63 mmHg right and 12 mmHg left. The right eye showed turbid anterior chamber, leading to the diagnosis of phacolytic glaucoma. The right eye was treated by paracentesis using a 27 G injection needle under topical anesthesia. IOP was controlled under 20 mmHg after 7 sessions of paracentesis. She has been doing well for 9 months until present. Conclusion：Repeated paracentesis was effective for phacolytic glaucoma.